GABORONE, Botswana – When 50-year-old Diana (not her real name) was diagnosed with stage 3 cervical cancer here in 2010, she initially believed it was a death sentence.
“The doctor who diagnosed me scared me – he told me that the cancer was at the ‘death stage,’” she said. “It was only after speaking to a counselor that I developed hope.” A clinical social worker at the same hospital explained that her cancer was indeed advanced, but that others in the same situation had survived.
However, this hope soon turned into frustration as Diana began the process of registering for treatment.
“I first had to go through the procedures at the public hospital before they could refer me to the private hospital for treatment,” she said. “Once the private hospital confirmed that I did indeed have cancer, I then went through the process of enrolling for radiation and chemotherapy, and that took some time.”
After four months, Diana eventually completed the registration process and, thanks to her relatively strong health, she embarked on an aggressive treatment plan of chemotherapy and radiation. In 2011, she was declared cancer-free and has remained so ever since.
Though she was relieved to have survived this scare, Diana believes that a lot more should be done to make the registration process smoother for patients who are already going through the trauma of a cancer diagnosis.
“You go through hell,” she said. “Imagine if you are already weak and have to wait four months – in four months, you could die!”
Medical practitioners, too, recognize the need for a better system. A new team from the Botswana-UPenn Partnership recently set out to create it at Princess Marina Hospital, located in the capital, Gaborone, which receives the majority of cervical cancer referrals in the country.
Dr. Surbhi Grover, the head of the gynecological oncology multidisciplinary team (MDT), explained that they managed to drastically reduce wait times by simply introducing a weekly meeting where radiation oncologists, clinical oncologists, surgeons, nurses and palliative care specialists can all sit down together to review cases and develop a plan to provide the best evidence-based care for each patient. Not all of these specialists are in residence at Princess Marina hospital, so without this weekly meeting, they would not all cross paths.
The last time the Botswana-UPenn team analyzed their data, between May 2015 and December 2015, they noted that the median delay from the date of biopsy to the start of radiation treatment went down to 39 days, a significant improvement from the previous 108 days. In addition, 62 percent of patients who visited the clinic only needed one visit for care coordination, whereas before, all patients would need to make multiple visits to see multiple specialists.
Dr. Grover said that prior to the implementation of these weekly meetings, patients were getting lost in the system.
“There was no clear system in place, so you would find that a patient could get a biopsy and the surgeon would make a plan and the oncologist would also make a plan, but they would be different because they were not talking to each other. Or it could take another two weeks for them to manage to get in touch with each other, resulting in confusion and delays. By doing this [weekly meetings], we are eliminating a lot of back and forth.”
This is good news in a country where cervical cancer is the most common cancer among women. Estimates indicate that every year, 250 women are diagnosed with cervical cancer and 111 die from the disease. In addition, 75 percent of cervical cancer patients in Botswana suffer from advanced forms of the disease.
Dr. Grover says the next step is to do more to ensure early detection, notably by increasing awareness of the need for screening.
“If you get someone at a really advanced stage, it will be really difficult to treat the disease and get the cancer under control,” she said. “But also, the patient will be in really poor shape […] and you cannot give them really aggressive treatments, so the outcome is just terrible.”